U.S. patent application number 12/126185 was filed with the patent office on 2008-11-27 for accommodation compensation systems and methods.
This patent application is currently assigned to AMO Development, LLC. Invention is credited to Guang-Ming Dai, Leander Zickler.
Application Number | 20080291395 12/126185 |
Document ID | / |
Family ID | 39688835 |
Filed Date | 2008-11-27 |
United States Patent
Application |
20080291395 |
Kind Code |
A1 |
Dai; Guang-Ming ; et
al. |
November 27, 2008 |
ACCOMMODATION COMPENSATION SYSTEMS AND METHODS
Abstract
Methods and systems for obtaining an ocular aberration
measurement of an eye of a patient are provided. Exemplary
techniques involve obtaining a first induced metric for the eye
that corresponds to a first accommodation state of the eye,
obtaining a second induced metric for the eye that corresponds to a
second accommodation state of the eye, and determining a natural
metric of the eye based on the first and second induced metrics. An
induced metric may include a pupil size or a spherical aberration.
Techniques can also include determining a target metric for the eye
base on the natural metric, determining whether an actual metric of
the eye meets the target metric, obtaining an ocular aberration
measurement of the eye if the actual metric meets the target
metric, and determining a treatment for the eye based on the ocular
aberration measurement.
Inventors: |
Dai; Guang-Ming; (Fremont,
CA) ; Zickler; Leander; (Menlo Park, CA) |
Correspondence
Address: |
TOWNSEND AND TOWNSEND AND CREW, LLP
TWO EMBARCADERO CENTER, EIGHTH FLOOR
SAN FRANCISCO
CA
94111-3834
US
|
Assignee: |
AMO Development, LLC
Santa Ana
CA
|
Family ID: |
39688835 |
Appl. No.: |
12/126185 |
Filed: |
May 23, 2008 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60940014 |
May 24, 2007 |
|
|
|
Current U.S.
Class: |
351/205 ;
351/246 |
Current CPC
Class: |
A61B 3/107 20130101;
A61F 9/00804 20130101; A61F 2009/00895 20130101; A61F 2009/00872
20130101; A61F 2009/00897 20130101; A61B 3/0025 20130101; A61F
9/008 20130101; A61B 3/112 20130101; A61F 2009/0088 20130101; A61B
3/14 20130101; A61B 3/1015 20130101; A61F 2009/0087 20130101; G02C
7/041 20130101 |
Class at
Publication: |
351/205 ;
351/246 |
International
Class: |
A61B 3/11 20060101
A61B003/11; A61B 3/10 20060101 A61B003/10 |
Claims
1. A method of obtaining an ocular aberration measurement of an eye
of a patient, comprising: obtaining a first induced metric for the
eye that corresponds to a first accommodation state of the eye;
obtaining a second induced metric for the eye that corresponds to a
second accommodation state of the eye; and determining a natural
metric of the eye based on the first and second induced
metrics.
2. The method according to claim 1, wherein the first induced
metric comprises a first induced pupil size or a first induced
spherical aberration, the second induced metric comprises a second
induced pupil size or a second induced spherical aberration, and
the natural metric comprises a natural pupil size or a natural
spherical aberration.
3. The method according to claim 1, further comprising determining
a target metric for the eye base on the natural metric.
4. The method according to claim 3, wherein the target metric
comprises a target pupil size or a target spherical aberration.
5. The method according to claim 3, further comprising determining
whether an actual metric of the eye meets the target metric.
6. The method according to claim 5, further comprising alerting an
operator if the actual metric does not meet the target metric.
7. The method according to claim 5, wherein the actual metric
comprises an actual pupil size or an actual spherical
aberration.
8. The method according to claim 5, further comprising obtaining an
ocular aberration measurement of the eye if the actual metric meets
the target metric.
9. The method according to claim 8, wherein the ocular aberration
measurement comprises a member selected from the group consisting
of a wavescan aberrometer examination, a contact lens aberrometer
examination, and an IOL aberrometer examination.
10. The method according to claim 8, further comprising determining
a treatment for the eye based on the ocular aberration
measurement.
11. The method according to claim 10, further comprising
administering the treatment to the eye.
12. A method of obtaining an ocular aberration measurement of an
eye of a patient, comprising: obtaining a first induced metric for
the eye that corresponds to a first viewing condition; obtaining a
second induced metric for the eye that corresponds to a second
viewing condition; determining a difference between the first
induced metric and the second induced metric; and determining an
accommodation characteristic of the eye if the difference between
the first induced metric and the second induced metric does not
exceed a threshold.
13. The method according to claim 12, comprising: determining a
target metric based on the accommodation characteristic;
determining whether an actual metric of the eye meets the target
metric; and obtaining an ocular aberration measurement of the eye
if the actual metric meets the target metric.
14. The method according to claim 12, wherein the first induced
metric comprises a first induced pupil size, the second induced
metric comprises a second induced pupil size, and the accommodation
characteristic comprises a minimally accommodated pupil size.
15. The method according to claim 13, wherein the target metric
comprises a target pupil size, and the actual metric comprises an
actual pupil size.
16. The method according to claim 12, wherein the first induced
metric comprises a first induced spherical aberration, the second
induced metric comprises a second induced spherical aberration, and
the accommodation characteristic comprises an minimally
accommodated spherical aberration.
17. The method according to claim 13, wherein the target metric
comprises a target spherical aberration, and the actual metric
comprises an actual spherical aberration.
18. The method according to claim 12, wherein the ocular aberration
measurement comprises a member selected from the group consisting
of a wavescan aberrometer examination, a contact lens aberrometer
examination, and an IOL aberrometer examination.
19. The method according to claim 13, further comprising alerting
an operator if the actual metric does not meet the target
metric.
20. The method according to claim 13, further comprising
determining a treatment for the eye based on the ocular aberration
measurement.
21. The method according to claim 20, further comprising
administering the treatment to the eye.
22. A method of determining a presbyopia treatment for an eye of a
patient, comprising: obtaining a first induced metric for the eye
that corresponds to a first viewing condition; obtaining a second
induced metric for the eye that corresponds to a second viewing
condition; determining a difference between the first induced
metric and the second induced metric; determining an accommodation
characteristic of the eye if the difference between the first
induced metric and the second induced metric does not exceed a
threshold; determining a residual accommodation of the eye based on
the accommodation characteristic; obtaining an ocular aberration
measurement of the eye; and determining a presbyopia treatment for
the eye based on the residual accommodation and the ocular
aberration measurement.
23. The method according to claim 22, wherein the first induced
metric comprises a first induced pupil size, the second induced
metric comprises a second induced pupil size, the accommodation
characteristic comprises a maximally accommodated pupil size, the
target metric comprises a target pupil size, and the actual metric
comprises an actual pupil size.
24. The method according to claim 22, wherein the first induced
metric comprises a first induced spherical aberration, the second
induced metric comprises a second induced spherical aberration, the
accommodation characteristic comprises an maximally accommodated
spherical aberration, the target metric comprises a target
spherical aberration, and the actual metric comprises an actual
spherical aberration.
25. The method according to claim 22, wherein the ocular aberration
measurement comprises a member selected from the group consisting
of a wavescan aberrometer examination, a contact lens aberrometer
examination, and an IOL aberrometer examination.
26. The method according to claim 22, further comprising
administering the presbyopia treatment to the eye.
27. A system for obtaining an ocular aberration measurement of an
eye of a patient, comprising: a first input configured to receive a
first induced metric for the eye that corresponds to a first
accommodation state of the eye; a second input configured to
receive a second induced metric for the eye that corresponds to a
second accommodation state of the eye; and a module configured to
determine a natural metric of the eye based on the first and second
induced metrics.
28. The system according to claim 27, wherein the first induced
metric comprises a first induced pupil size or a first induced
spherical aberration, the second induced metric comprises a second
induced pupil size or a second induced spherical aberration, and
the natural metric comprises a natural pupil size or a natural
spherical aberration.
29. A system for obtaining an ocular aberration measurement of an
eye of a patient, comprising: a first input configured to receive a
first induced metric for the eye that corresponds to a first
viewing condition; a second input configured to receive a second
induced metric for the eye that corresponds to a second viewing
condition; a first module configured to determine a difference
between the first induced metric and the second induced metric; and
a second module configured to determine an accommodation
characteristic of the eye if the difference between the first
induced metric and the second induced metric does not exceed a
threshold.
30. The system according to claim 29, comprising: a third module
configured to determine a target metric based on the accommodation
characteristic; a fourth module configured to determine whether an
actual metric of the eye meets the target metric; and a fifth
module configured to receive an ocular aberration measurement of
the eye if the actual metric meets the target metric.
31. A system for determining a presbyopia treatment for an eye of a
patient, comprising: a first input configured to receive a first
induced metric for the eye that corresponds to a first viewing
condition; a second input configured to receive a second induced
metric for the eye that corresponds to a second viewing condition;
a first module configured to determine a difference between the
first induced metric and the second induced metric; a second module
configured to determine an accommodation characteristic of the eye
if the difference between the first induced metric and the second
induced metric does not exceed a threshold; a third module
configured to determine a residual accommodation of the eye based
on the accommodation characteristic; a fourth module configured to
receive an ocular aberration measurement of the eye; and a fifth
module configured to determine a presbyopia treatment for the eye
based on the residual accommodation and the ocular aberration
measurement.
Description
CROSS-REFERENCES TO RELATED APPLICATIONS
[0001] This application claims the benefit of U.S. Provisional
Patent Application No. 60/940,014 filed May 24, 2007. This
application is also related to U.S. patent application Ser. Nos.
10/872,331 and 11/156,257, filed Jun. 17, 2004 Jun. 17, 2005
respectively. The entire disclosure of each of these filings is
incorporated herein by reference for all purposes.
BACKGROUND OF THE INVENTION
[0002] Embodiments of the present invention relate to systems,
devices, and methods for compensating voluntary and other
accommodation of patients during ocular diagnostic and treatment
procedures. In particular, embodiments provide techniques for
improving the accuracy of ocular aberration measurements and the
development of vision correction treatments by evaluating
accommodation in a patient.
[0003] An ocular wavefront measurement can change dramatically as
the eye accommodates and the lens shape changes. This measurement
change can be manifested in a Hartmann-Shack spot pattern as a
pincushion effect. Current wavefront-based refractometers often
derive a patient's total refraction, or total ocular aberration,
from a single measurement under the assumption that accommodation
has been effectively suppressed. Yet patients can experience some
degree of instrument myopia when such measurements are taken, as
the eye tends to accommodate inappropriately when viewing though an
optical instrument. For example, when a patient looks through an
optical instrument such as a refractometer or an aberrometer, the
eye often responds by accommodating more than would be necessary
for natural viewing. In some cases this excess accommodation, or
instrument myopia, can be on the order of several diopters. As a
result, the effect of instrument myopia can lead to an inaccurate
measurement of refraction.
[0004] A variety of approaches have been proposed to eliminate
instrument myopia. In some cases, a doctor may try to simulate the
object being viewed, for example a viewing target, as far away from
the patient as possible such that the target is closer to optical
infinity. When an eye is gazing at a far distance the eye lens is
thin and relaxed, and accommodation is reduced. Another technique
that attempts to cause eye to relax the accommodation mechanism
involves fogging. Fogging can involve adding a small amount of plus
sphere power with a convex spherical lens, to provide a slight
overcorrection. When the eye is optically fogged, vision becomes
blurrier as the eye accommodates, and thus accommodation is
discouraged. Additional techniques involve asking the patient to
relax their vision. However many patients do not respond as desired
to such approaches. Even when these accommodation-elimination
techniques are implemented some instrument myopia may persist. What
is more, it is often difficult to determine whether the eye is
accommodated or not, particularly when a doctor or other instrument
operator making such a determination is inexperienced.
[0005] What is needed are systems and methods for reducing the
amount of instrument myopia present in the eye during an optical
measurement. Moreover, improved techniques are desired for
determining residual accommodation of the eye. Relatedly, there is
a need for systems and methods that can accurately determine
whether a patient's eye is accommodated, or the degree to which the
patient's eye is accommodated. Embodiments of the present invention
provide solutions to at least some of these problems.
BRIEF SUMMARY OF THE INVENTION
[0006] Systems, methods, and software are provided for compensating
voluntary accommodation in a patient eye during a wavefront
measurement. These approaches can be used to improve the accuracy
of the ocular aberration measurement, and to improve the treatment
of patients using laser vision correction of wavefront-driven
procedures. Moreover, these approaches can be used to measure the
residual accommodation of presbyopic patients to customize or
optimize a presbyopic treatment. Embodiments of the present
invention provide improved techniques for evaluating the
accommodation state of a patient's eye, as well as for eliminating,
reducing, or compensating for unwanted accommodation. For example,
embodiments may encompass method and techniques for determining the
amount of accommodation in an eye, determining the degree to which
an eye is accommodated, the accommodation status of an eye, and the
like. Similarly, embodiments encompass methods of designing optical
treatment shapes for vision correction, such as presbyopia
refraction shapes, based on the accommodation characteristics of
the patient eye. These shapes are well suited for implementation in
any of a variety of vision correction modalities, including
accommodating IOLs, custom IOLs, contact lenses, laser vision
correction, and the like.
[0007] In a first aspect, embodiments of the present invention
provide methods of obtaining an ocular aberration measurement of an
eye of a patient. Methods can include obtaining a first induced
metric for the eye that corresponds to a first accommodation state
of the eye, obtaining a second induced metric for the eye that
corresponds to a second accommodation state of the eye, and
determining a natural metric of the eye based on the first and
second induced metrics. In some cases, the first induced metric can
include a first induced pupil size or a first induced spherical
aberration, the second induced metric can include a second induced
pupil size or a second induced spherical aberration, and the
natural metric can include a natural pupil size or a natural
spherical aberration. Methods can also include determining a target
metric for the eye base on the natural metric. A target metric can
include a target pupil size or a target spherical aberration. In
some cases, methods include determining whether an actual metric of
the eye meets the target metric. Methods can also include alerting
an operator if the actual metric does not meet the target metric.
In some cases, an actual metric includes an actual pupil size or an
actual spherical aberration. Methods can also include obtaining an
ocular aberration measurement of the eye if the actual metric meets
the target metric. An ocular aberration measurement can include a
wavescan aberrometer examination, a contact lens aberrometer
examination, an IOL aberrometer examination, or the like. In some
cases, methods include determining a treatment for the eye based on
the ocular aberration measurement. Methods can also include
administering the treatment to the eye.
[0008] In another aspect, embodiments of the present invention
encompass methods of obtaining an ocular aberration measurement of
an eye of a patient, which can involve obtaining a first induced
metric for the eye that corresponds to a first viewing condition,
obtaining a second induced metric for the eye that corresponds to a
second viewing condition, determining a difference between the
first induced metric and the second induced metric, and determining
an accommodation characteristic of the eye if the difference
between the first induced metric and the second induced metric does
not exceed a threshold. In some cases, methods can include
determining a target metric based on the accommodation
characteristic, determining whether an actual metric of the eye
meets the target metric, and obtaining an ocular aberration
measurement of the eye if the actual metric meets the target
metric. In some cases, a first induced metric includes a first
induced pupil size, a second induced metric includes a second
induced pupil size, and an accommodation characteristic includes a
minimally accommodated pupil size. A target metric can include a
target pupil size, and an actual metric can include an actual pupil
size. A first induced metric can include a first induced spherical
aberration, a second induced metric can include a second induced
spherical aberration, and an accommodation characteristic can
include an minimally accommodated spherical aberration. In some
cases, a target metric includes a target spherical aberration, and
an actual metric includes an actual spherical aberration. An ocular
aberration measurement can include, for example, a wavescan
aberrometer examination, a contact lens aberrometer examination, an
IOL aberrometer examination, or the like. In some cases, methods
include alerting an operator if the actual metric does not meet the
target metric. Methods can also include determining a treatment for
the eye based on an ocular aberration measurement. Similarly,
methods can include administering the treatment to the eye.
[0009] In some aspects, embodiments of the present invention
encompass methods of determining a presbyopia treatment for an eye
of a patient. Methods can include, for example, obtaining a first
induced metric for the eye that corresponds to a first viewing
condition, obtaining a second induced metric for the eye that
corresponds to a second viewing condition, determining a difference
between the first induced metric and the second induced metric,
determining an accommodation characteristic of the eye if the
difference between the first induced metric and the second induced
metric does not exceed a threshold, determining a residual
accommodation of the eye based on the accommodation characteristic,
obtaining an ocular aberration measurement of the eye, and
determining a presbyopia treatment for the eye based on the
residual accommodation and the ocular aberration measurement. In
some cases, a first induced metric includes a first induced pupil
size, a second induced metric includes a second induced pupil size,
an accommodation characteristic includes a maximally accommodated
pupil size, a target metric includes a target pupil size, and an
actual metric includes an actual pupil size. A first induced metric
can include a first induced spherical aberration, a second induced
metric can include a second induced spherical aberration, an
accommodation characteristic can include an maximally accommodated
spherical aberration, a target metric can include a target
spherical aberration, and an actual metric can include an actual
spherical aberration. An ocular aberration measurement can include
a wavescan aberrometer examination, a contact lens aberrometer
examination, an IOL aberrometer examination, or the like. In some
cases, methods include administering the presbyopia treatment to
the eye.
[0010] In another aspect, embodiments of the present invention
include systems for obtaining an ocular aberration measurement of
an eye of a patient. A system may include, for example, a first
input configured to receive a first induced metric for the eye that
corresponds to a first accommodation state of the eye, a second
input configured to receive a second induced metric for the eye
that corresponds to a second accommodation state of the eye, and a
module configured to determine a natural metric of the eye based on
the first and second induced metrics. A first induced metric can
include a first induced pupil size or a first induced spherical
aberration, a second induced metric can include a second induced
pupil size or a second induced spherical aberration, and a natural
metric can include a natural pupil size or a natural spherical
aberration.
[0011] In a further aspect, embodiments of the present invention
include systems for obtaining an ocular aberration measurement of
an eye of a patient, which can include a first input configured to
receive a first induced metric for the eye that corresponds to a
first viewing condition, a second input configured to receive a
second induced metric for the eye that corresponds to a second
viewing condition, a first module configured to determine a
difference between the first induced metric and the second induced
metric, and a second module configured to determine an
accommodation characteristic of the eye if the difference between
the first induced metric and the second induced metric does not
exceed a threshold. In some cases, systems can include a module
configured to determine a target metric based on the accommodation
characteristic, a module configured to determine whether an actual
metric of the eye meets the target metric, and a module configured
to receive an ocular aberration measurement of the eye if the
actual metric meets the target metric.
[0012] In some aspects, embodiments of the present invention
encompass systems for determining a presbyopia treatment for an eye
of a patient. Systems can include, for example, an input configured
to receive a first induced metric for the eye that corresponds to a
first viewing condition, an input configured to receive a second
induced metric for the eye that corresponds to a second viewing
condition, a module configured to determine a difference between
the first induced metric and the second induced metric, a module
configured to determine an accommodation characteristic of the eye
if the difference between the first induced metric and the second
induced metric does not exceed a threshold, a module configured to
determine a residual accommodation of the eye based on the
accommodation characteristic, a module configured to receive an
ocular aberration measurement of the eye, and a module configured
to determine a presbyopia treatment for the eye based on the
residual accommodation and the ocular aberration measurement.
[0013] In some aspect, embodiments of the present invention provide
a method of obtaining a residual accommodation measurement of an
eye of a patient. The method may include, for example, obtaining a
first induced metric for the eye that corresponds to a first
viewing condition, obtaining a second induced metric for the eye
that corresponds to a second viewing condition, determining if a
difference between the first induced metric and the second induced
metric exceeds a threshold, determining an accommodation
characteristic of the eye if the difference between the first
induced metric and the second induced metric does not exceed the
threshold, and determining the residual accommodation measurement
of the eye based on the accommodation characteristic. In some
cases, the first induced metric comprises a first induced pupil
size, the second induced metric comprises a second induced pupil
size, and the accommodation characteristic comprises a maximally
accommodated pupil size. In some cases, the first induced metric
comprises a first induced spherical aberration, the second induced
metric comprises a second induced spherical aberration, and the
accommodation characteristic comprises a maximally accommodated
spherical aberration.
[0014] In some aspects, embodiments of the present invention
provide a method of determining a natural metric of an
unaccommodated eye. The method may include, for example, inputting
a first induced metric for the eye that corresponds to a first
accommodation state of the eye, inputting a second induced metric
for the eye that corresponds to a second accommodation state of the
eye, and determining the natural metric of the unaccommodated or
minimally accommodated eye based on the first and second induced
metrics and the first and second accommodation states of the eye.
For example, the first and second induced metrics can be input into
an input module, and the natural metric can be determined by a
determination module. The natural metric can be an aberration
metric or a pupil size metric. Optionally, the method may include
inputting three or more induced metrics corresponding to respective
accommodation states of the eye, and determining the natural metric
of the unaccommodated or minimally accommodated eye based on a
combination of two or more of the induced metrics. The aberration
metric can be a spherical aberration metric, a sphere metric, or a
coma metric. The method may also include determining a target
metric for the unaccommodated or minimally accommodated eye based
on the natural metric. Further, the method may include determining
an actual metric of the eye. In some cases, the method may include
determining whether the actual metric meets the target metric. The
method may also include obtaining an ocular aberration measurement
of the eye if the natural metric meets a target metric. The ocular
aberration measurement can include, for example, a wavescan
measurement. In some cases, the unaccommodated or minimally
accommodated eye has a power of zero diopters.
[0015] In some aspects, embodiments encompass a method of
determining a natural pupil size metric of an unaccommodated or
minimally accommodated eye. The method can include inputting a
first induced pupil size metric for the eye that corresponds to a
first accommodation state of the eye, inputting a second induced
pupil size metric for the eye that corresponds to a second
accommodation state of the eye, and determining the natural pupil
size metric of the unaccommodated or minimally accommodated eye
based on the first and second induced pupil size metrics and the
first and second accommodation states of the eye.
[0016] For a fuller understanding of the nature and advantages of
the present invention, reference should be had to the ensuing
detailed description taken in conjunction with the accompanying
drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0017] FIG. 1 illustrates a laser ablation system according to an
embodiment of the present invention.
[0018] FIG. 2 illustrates a simplified computer system according to
an embodiment of the present invention.
[0019] FIG. 3 illustrates a wavefront measurement system according
to an embodiment of the present invention.
[0020] FIG. 3A illustrates another wavefront measurement system
according to an embodiment of the present invention.
[0021] FIG. 4 schematically illustrates method embodiments of the
present invention.
[0022] FIG. 5 depicts methods aspects of exemplary embodiments of
the present invention.
[0023] FIGS. 6A-6C illustrate the effects of changing focal
distance on a patient's lens, according to embodiments of the
present invention.
[0024] FIGS. 7A-7E illustrate relationships involving ocular
characteristics of an eye according to embodiments of the present
invention.
[0025] FIG. 8 depicts relationships between accommodation, pupil
size, and net spherical aberration according to embodiments of the
present invention.
[0026] FIG. 9 depicts relationships between accommodation, pupil
size, and net spherical aberration according to embodiments of the
present invention.
DETAILED DESCRIPTION OF THE INVENTION
[0027] The present invention can be readily adapted for use with
existing laser systems, wavefront measurement systems, and other
optical measurement devices. Although the systems, software, and
methods of the present invention are described primarily in the
context of a laser eye surgery system, it should be understood the
present invention may be adapted for use in alternative eye
treatment procedures, systems, or modalities, such as spectacle
lenses, intraocular lenses, accommodating IOLs, contact lenses,
corneal ring implants, collagenous corneal tissue thermal
remodeling, corneal inlays, corneal onlays, other corneal implants
or grafts, and the like. Relatedly, systems, software, and methods
according to embodiments of the present invention are well suited
for customizing any of these treatment modalities to a specific
patient. Thus, for example, embodiments encompass custom
intraocular lenses, custom contact lenses, custom corneal implants,
and the like, which can be configured to treat or ameliorate any of
a variety of vision conditions in a particular patient based on
their unique ocular characteristics or anatomy.
[0028] Turning now to the drawings, FIG. 1 illustrates a laser eye
surgery system 10 of the present invention, including a laser 12
that produces a laser beam 14. Laser 12 is optically coupled to
laser delivery optics 16, which directs laser beam 14 to an eye E
of patient P. A delivery optics support structure (not shown here
for clarity) extends from a frame 18 supporting laser 12. A
microscope 20 is mounted on the delivery optics support structure,
the microscope often being used to image a cornea of eye E.
[0029] Laser 12 generally comprises an excimer laser, ideally
comprising an argon-fluorine laser producing pulses of laser light
having a wavelength of approximately 193 nm. Laser 12 will
preferably be designed to provide a feedback stabilized fluence at
the patient's eye, delivered via delivery optics 16. The present
invention may also be useful with alternative sources of
ultraviolet or infrared radiation, particularly those adapted to
controllably ablate the corneal tissue without causing significant
damage to adjacent and/or underlying tissues of the eye. Such
sources include, but are not limited to, solid state lasers and
other devices which can generate energy in the ultraviolet
wavelength between about 185 and 205 nm and/or those which utilize
frequency-multiplying techniques. Hence, although an excimer laser
is the illustrative source of an ablating beam, other lasers may be
used in the present invention.
[0030] Laser system 10 will generally include a computer or
programmable processor 22. Processor 22 may comprise (or interface
with) a conventional PC system including the standard user
interface devices such as a keyboard, a display monitor, and the
like. Processor 22 will typically include an input device such as a
magnetic or optical disk drive, an internet connection, or the
like. Such input devices will often be used to download a computer
executable code from a tangible storage media 29 embodying any of
the methods of the present invention. Tangible storage media 29 may
take the form of a floppy disk, an optical disk, a data tape, a
volatile or non-volatile memory, RAM, or the like, and the
processor 22 will include the memory boards and other standard
components of modem computer systems for storing and executing this
code. Tangible storage media 29 may optionally embody wavefront
sensor data, wavefront gradients, a wavefront elevation map, a
treatment map, a corneal elevation map, and/or an ablation table.
While tangible storage media 29 will often be used directly in
cooperation with a input device of processor 22, the storage media
may also be remotely operatively coupled with processor by means of
network connections such as the internet, and by wireless methods
such as infrared, Bluetooth, or the like.
[0031] Laser 12 and delivery optics 16 will generally direct laser
beam 14 to the eye of patient P under the direction of a computer
22. Computer 22 will often selectively adjust laser beam 14 to
expose portions of the cornea to the pulses of laser energy so as
to effect a predetermined sculpting of the cornea and alter the
refractive characteristics of the eye. In many embodiments, both
laser beam 14 and the laser delivery optical system 16 will be
under computer control of processor 22 to effect the desired laser
sculpting process, with the processor effecting (and optionally
modifying) the pattern of laser pulses. The pattern of pulses may
by summarized in machine readable data of tangible storage media 29
in the form of a treatment table, and the treatment table may be
adjusted according to feedback input into processor 22 from an
automated image analysis system in response to feedback data
provided from an ablation monitoring system feedback system.
Optionally, the feedback may be manually entered into the processor
by a system operator. Such feedback might be provided by
integrating the wavefront measurement system described below with
the laser treatment system 10, and processor 22 may continue and/or
terminate a sculpting treatment in response to the feedback, and
may optionally also modify the planned sculpting based at least in
part on the feedback. Measurement systems are further described in
U.S. Pat. No. 6,315,413, the full disclosure of which is
incorporated herein by reference.
[0032] Laser beam 14 may be adjusted to produce the desired
sculpting using a variety of alternative mechanisms. The laser beam
14 may be selectively limited using one or more variable apertures.
An exemplary variable aperture system having a variable iris and a
variable width slit is described in U.S. Pat. No. 5,713,892, the
full disclosure of which is incorporated herein by reference. The
laser beam may also be tailored by varying the size and offset of
the laser spot from an axis of the eye, as described in U.S. Pat.
Nos. 5,683,379, 6,203,539, and 6,331,177, the full disclosures of
which are incorporated herein by reference.
[0033] Still further alternatives are possible, including scanning
of the laser beam over the surface of the eye and controlling the
number of pulses and/or dwell time at each location, as described,
for example, by U.S. Pat. No. 4,665,913, the full disclosure of
which is incorporated herein by reference; using masks in the
optical path of laser beam 14 which ablate to vary the profile of
the beam incident on the cornea, as described in U.S. Pat. No.
5,807,379, the full disclosure of which is incorporated herein by
reference; hybrid profile-scanning systems in which a variable size
beam (typically controlled by a variable width slit and/or variable
diameter iris diaphragm) is scanned across the cornea; or the like.
The computer programs and control methodology for these laser
pattern tailoring techniques are well described in the patent
literature.
[0034] Additional components and subsystems may be included with
laser system 10, as should be understood by those of skill in the
art. For example, spatial and/or temporal integrators may be
included to control the distribution of energy within the laser
beam, as described in U.S. Pat. No. 5,646,791, the full disclosure
of which is incorporated herein by reference. Ablation effluent
evacuators/filters, aspirators, and other ancillary components of
the laser surgery system are known in the art. Further details of
suitable systems for performing a laser ablation procedure can be
found in commonly assigned U.S. Pat. Nos. 4,665,913, 4,669,466,
4,732,148, 4,770,172, 4,773,414, 5,207,668, 5,108,388, 5,219,343,
5,646,791 and 5,163,934, the complete disclosures of which are
incorporated herein by reference. Suitable systems also include
commercially available refractive laser systems such as those
manufactured and/or sold by Alcon, Bausch & Lomb, Nidek,
WaveLight, LaserSight, Schwind, Zeiss-Meditec, and the like. Basis
data can be further characterized for particular lasers or
operating conditions, by taking into account localized
environmental variables such as temperature, humidity, airflow, and
aspiration.
[0035] FIG. 2 is a simplified block diagram of an exemplary
computer system 22 that may be used by the laser surgical system 10
of the present invention. Computer system 22 typically includes at
least one processor 52 which may communicate with a number of
peripheral devices via a bus subsystem 54. These peripheral devices
may include a storage subsystem 56, comprising a memory subsystem
58 and a file storage subsystem 60, user interface input devices
62, user interface output devices 64, and a network interface
subsystem 66. Network interface subsystem 66 provides an interface
to outside networks 68 and/or other devices, such as the wavefront
measurement system 30.
[0036] User interface input devices 62 may include a keyboard,
pointing devices such as a mouse, trackball, touch pad, or graphics
tablet, a scanner, foot pedals, a joystick, a touchscreen
incorporated into the display, audio input devices such as voice
recognition systems, microphones, and other types of input devices.
User input devices 62 will often be used to download a computer
executable code from a tangible storage media 29 embodying any of
the methods of the present invention. In general, use of the term
"input device" is intended to include a variety of conventional and
proprietary devices and ways to input information into computer
system 22.
[0037] User interface output devices 64 may include a display
subsystem, a printer, a fax machine, or non-visual displays such as
audio output devices. The display subsystem may be a cathode ray
tube (CRT), a flat-panel device such as a liquid crystal display
(LCD), a projection device, or the like. The display subsystem may
also provide a non-visual display such as via audio output devices.
In general, use of the term "output device" is intended to include
a variety of conventional and proprietary devices and ways to
output information from computer system 22 to a user.
[0038] Storage subsystem 56 can store the basic programming and
data constructs that provide the functionality of the various
embodiments of the present invention. For example, a database and
modules implementing the functionality of the methods of the
present invention, as described herein, may be stored in storage
subsystem 56. These software modules are generally executed by
processor 52. In a distributed environment, the software modules
may be stored on a plurality of computer systems and executed by
processors of the plurality of computer systems. Storage subsystem
56 typically comprises memory subsystem 58 and file storage
subsystem 60.
[0039] Memory subsystem 58 typically includes a number of memories
including a main random access memory (RAM) 70 for storage of
instructions and data during program execution and a read only
memory (ROM) 72 in which fixed instructions are stored. File
storage subsystem 60 provides persistent (non-volatile) storage for
program and data files, and may include tangible storage media 29
(FIG. 1) which may optionally embody wavefront sensor data,
wavefront gradients, a wavefront elevation map, a treatment map,
and/or an ablation table. File storage subsystem 60 may include a
hard disk drive, a floppy disk drive along with associated
removable media, a Compact Digital Read Only Memory (CD-ROM) drive,
an optical drive, DVD, CD-R, CD-RW, solid-state removable memory,
and/or other removable media cartridges or disks. One or more of
the drives may be located at remote locations on other connected
computers at other sites coupled to computer system 22. The modules
implementing the functionality of the present invention may be
stored by file storage subsystem 60.
[0040] Bus subsystem 54 provides a mechanism for letting the
various components and subsystems of computer system 22 communicate
with each other as intended. The various subsystems and components
of computer system 22 need not be at the same physical location but
may be distributed at various locations within a distributed
network. Although bus subsystem 54 is shown schematically as a
single bus, alternate embodiments of the bus subsystem may utilize
multiple busses.
[0041] Computer system 22 itself can be of varying types including
a personal computer, a portable computer, a workstation, a computer
terminal, a network computer, a control system in a wavefront
measurement system or laser surgical system, a mainframe, or any
other data processing system. Due to the ever-changing nature of
computers and networks, the description of computer system 22
depicted in FIG. 2 is intended only as a specific example for
purposes of illustrating one embodiment of the present invention.
Many other configurations of computer system 22 are possible having
more or less components than the computer system depicted in FIG.
2.
[0042] Referring now to FIG. 3, one embodiment of a wavefront
measurement system 30 is schematically illustrated in simplified
form. In very general terms, wavefront measurement system 30 is
configured to sense local slopes of a gradient map exiting the
patient's eye. Devices based on the Hartmann-Shack principle
generally include a lenslet array to sample the gradient map
uniformly over an aperture, which is typically the exit pupil of
the eye. Thereafter, the local slopes of the gradient map are
analyzed so as to reconstruct the wavefront surface or map.
[0043] More specifically, one wavefront measurement system 30
includes an image source 32, such as a laser, which projects a
source image through optical tissues 34 of eye E so as to form an
image 44 upon a surface of retina R. The image from retina R is
transmitted by the optical system of the eye (e.g., optical tissues
34) and imaged onto a wavefront sensor 36 by system optics 37. The
wavefront sensor 36 communicates signals to a computer system 22'
for measurement of the optical errors in the optical tissues 34
and/or determination of an optical tissue ablation treatment
program. Computer 22' may include the same or similar hardware as
the computer system 22 illustrated in FIGS. 1 and 2. Computer
system 22' may be in communication with computer system 22 that
directs the laser surgery system 10, or some or all of the
components of computer system 22, 22' of the wavefront measurement
system 30 and laser surgery system 10 may be combined or separate.
If desired, data from wavefront sensor 36 may be transmitted to a
laser computer system 22 via tangible media 29, via an I/O port,
via an networking connection 66 such as an intranet or the
Internet, or the like.
[0044] Wavefront sensor 36 generally comprises a lenslet array 38
and an image sensor 40. As the image from retina R is transmitted
through optical tissues 34 and imaged onto a surface of image
sensor 40 and an image of the eye pupil P is similarly imaged onto
a surface of lenslet array 38, the lenslet array separates the
transmitted image into an array of beamlets 42, and (in combination
with other optical components of the system) images the separated
beamlets on the surface of sensor 40. Sensor 40 typically comprises
a charged couple device or "CCD," and senses the characteristics of
these individual beamlets, which can be used to determine the
characteristics of an associated region of optical tissues 34. In
particular, where image 44 comprises a point or small spot of
light, a location of the transmitted spot as imaged by a beamlet
can directly indicate a local gradient of the associated region of
optical tissue.
[0045] Eye E generally defines an anterior orientation ANT and a
posterior orientation POS. Image source 32 generally projects an
image in a posterior orientation through optical tissues 34 onto
retina R as indicated in FIG. 3. Optical tissues 34 again transmit
image 44 from the retina anteriorly toward wavefront sensor 36.
Image 44 actually formed on retina R may be distorted by any
imperfections in the eye's optical system when the image source is
originally transmitted by optical tissues 34. Optionally, image
source projection optics 46 may be configured or adapted to
decrease any distortion of image 44.
[0046] In some embodiments, image source optics 46 may decrease
lower order optical errors by compensating for spherical and/or
cylindrical errors of optical tissues 34. Higher order optical
errors of the optical tissues may also be compensated through the
use of an adaptive optic element, such as a deformable mirror
(described below). Use of an image source 32 selected to define a
point or small spot at image 44 upon retina R may facilitate the
analysis of the data provided by wavefront sensor 36. Distortion of
image 44 may be limited by transmitting a source image through a
central region 48 of optical tissues 34 which is smaller than a
pupil 50, as the central portion of the pupil may be less prone to
optical errors than the peripheral portion. Regardless of the
particular image source structure, it will be generally be
beneficial to have a well-defined and accurately formed image 44 on
retina R.
[0047] In one embodiment, the wavefront data may be stored in a
computer readable medium 29 or a memory of the wavefront sensor
system 30 in two separate arrays containing the x and y wavefront
gradient values obtained from image spot analysis of the
Hartmann-Shack sensor images, plus the x and y pupil center offsets
from the nominal center of the Hartmann-Shack lenslet array, as
measured by the pupil camera 51 (FIG. 3) image. Such information
contains all the available information on the wavefront error of
the eye and is sufficient to reconstruct the wavefront or any
portion of it. In such embodiments, there is no need to reprocess
the Hartmann-Shack image more than once, and the data space
required to store the gradient array is not large. For example, to
accommodate an image of a pupil with an 8 mm diameter, an array of
a 20.times.20 size (i.e., 400 elements) is often sufficient. As can
be appreciated, in other embodiments, the wavefront data may be
stored in a memory of the wavefront sensor system in a single array
or multiple arrays.
[0048] While the methods of the present invention will generally be
described with reference to sensing of an image 44, a series of
wavefront sensor data readings may be taken. For example, a time
series of wavefront data readings may help to provide a more
accurate overall determination of the ocular tissue aberrations. As
the ocular tissues can vary in shape over a brief period of time, a
plurality of temporally separated wavefront sensor measurements can
avoid relying on a single snapshot of the optical characteristics
as the basis for a refractive correcting procedure. Still further
alternatives are also available, including taking wavefront sensor
data of the eye with the eye in differing configurations,
positions, and/or orientations. For example, a patient will often
help maintain alignment of the eye with wavefront measurement
system 30 by focusing on a fixation target, as described in U.S.
Pat. No. 6,004,313, the full disclosure of which is incorporated
herein by reference. By varying a position of the fixation target
as described in that reference, optical characteristics of the eye
may be determined while the eye accommodates or adapts to image a
field of view at a varying distance and/or angles.
[0049] The location of the optical axis of the eye may be verified
by reference to the data provided from a pupil camera 52. In the
exemplary embodiment, a pupil camera 52 images pupil 50 so as to
determine a position of the pupil for registration of the wavefront
sensor data relative to the optical tissues.
[0050] An alternative embodiment of a wavefront measurement system
is illustrated in FIG. 3A. The major components of the system of
FIG. 3A are similar to those of FIG. 3. Additionally, FIG. 3A
includes an adaptive optical element 53 in the form of a deformable
mirror. The source image is reflected from deformable mirror 98
during transmission to retina R, and the deformable mirror is also
along the optical path used to form the transmitted image between
retina R and imaging sensor 40. Deformable mirror 98 can be
controllably deformed by computer system 22 to limit distortion of
the image formed on the retina or of subsequent images formed of
the images formed on the retina, and may enhance the accuracy of
the resultant wavefront data. The structure and use of the system
of FIG. 3A are more fully described in U.S. Pat. No. 6,095,651, the
full disclosure of which is incorporated herein by reference.
[0051] The components of an embodiment of a wavefront measurement
system for measuring the eye and ablations may comprise elements of
a WaveScan.RTM. system, available from VISX, INCORPORATED of Santa
Clara, Calif. One embodiment includes a WaveScan system with a
deformable mirror as described above. An alternate embodiment of a
wavefront measuring system is described in U.S. Pat. No. 6,271,915,
the full disclosure of which is incorporated herein by reference.
It is appreciated that any wavefront aberrometer could be employed
for use with the present invention. Relatedly, embodiments of the
present invention encompass the implementation of any of a variety
of optical instruments provided by WaveFront Sciences, Inc.,
including the COAS wavefront aberrometer, the ClearWave contact
lens aberrometer, the CrystalWave IOL aberrometer, and the
like.
[0052] In some embodiments, an aberrometer device can be used to
measure whole eye spherical aberration (SA), and a topography
device can be used to obtain a topography or spherical aberration
of a cornea. Based on the whole eye SA and the cornea SA, the SA of
the lens can be calculated. The change or difference in SA due to a
natural lens or an accommodating IOL can be determined. Hence,
accommodation can be measured. A wavefront may change as it
propagates from one plane to another. Thus, topographic aberrations
of the cornea can be represented at the exit pupil plane, and
aberrations of the entire eye can be represented at the exit pupil
plane. When deriving a difference between an ocular aberration and
a corneal aberration, the difference may be represented at the exit
pupil plane. When using the difference to determine an aberration
of a natural lens or an accommodating IOL, the representation of
the aberration may be translated, for example, to an IOL plane.
Wavefront propagation conversions are discussed in co-pending and
co-owned patent application Ser. No. 11/736,353 filed Apr. 17,
2007, the entire contents of which are hereby incorporated by
reference for all purposes.
[0053] Embodiments of the present invention provide systems,
methods, and devices for compensating voluntary accommodation of
patients during wavefront measurements. These techniques can be
used to improve the accuracy of the ocular aberration measurements
and to improve the treatment of patients using laser vision
correction treatments based on wavefront procedures. Such
approaches can also be used to measure the residual accommodation
of presbyopic patients and to customize treatment for such
patients.
[0054] It is often difficult with some current techniques to
achieve complete or desired lack of accommodation in a patient. For
example, some have estimated that about 5% of the patient
population presents unwanted accommodation during optical testing
and treatment procedures. The techniques disclosed herein provide
improved systems and methods that compel a patient's eye away from
an accommodated state and toward an unaccommodated or
deaccommodated state.
[0055] The amplitude of accommodation can be defined as the eye's
ability to focus at near. A child's eye may be able to focus at
about 2-3 inches, which corresponds to an amplitude of
accommodation of about 10-30 diopters. In contrast, a 45 year old
person may only be able to focus at about 20 inches, which
corresponds to an amplitude of accommodation of about 2
diopters.
[0056] FIG. 4 schematically illustrates method embodiments of the
present invention. These methods involve evaluating accommodation
characteristics of a patient's eye, and determining corrective
ocular treatments for the eye. Step 80 involves determining a
natural metric of an eye. A natural metric of the eye can include,
for example, the natural pupil size of the eye or the natural
spherical aberration of the eye. Often, the term natural metric
refers to a characteristic of the eye under natural conditions, in
the absence of influences that may be present during diagnostic or
testing procedures. For example, this term may indicate the pupil
size of the eye when the patient is not subject to a particular
diagnostic instrument. Accordingly, this term can be related to the
status of the eye where instrument myopia is absent or reduced.
[0057] The patient eye metric can include a pupil size or a
spherical aberration, as noted above. Patient eye metrics may also
include coma or trefoil. More broadly, metrics suitable for use
with embodiments of the present invention include low order
aberrations, high order aberrations, primary or secondary
astigmatism, primary or secondary coma, primary or secondary
sphere, primary or secondary spherical aberration, pupil size,
defocus, root mean square, high order root mean square with an
error, and the like. Metrics may also encompass combinations, for
example a metric may include coma and trefoil, which are third
order aberrations. Similarly, a metric may include secondary
astigmatism, spherical aberration, and quadrafoil, which are fourth
order aberrations. Metric embodiments also encompass fifth order
aberrations, sixth order aberrations, and the like. Such optical
metrics may change as the accommodation of the eye increases or
decreases. For example, the spherical aberration of the eye may
increase as the eye changes toward a more accommodated state. The
rate and magnitude of these metric changes often vary from patient
to patient, and can even vary between eyes in a single patient.
[0058] Certain individuals within a population may present ocular
characteristics which vary from the norm or from other individuals
within the population. For example, it has been observed what
within some populations, about 90 percent of the individuals
present a natural spherical aberration that is positive, and about
10 percent of the individuals present a natural spherical
aberration that is negative, when the eye is relaxed or
unaccommodated. In some embodiments, metrics can be determined or
evaluated with respect to ocular characteristics exhibited by a
population or set of individuals. For example, a metric can be
based on an average or mean pupil size of a group of individuals.
Similarly, a metric can be based on an average or mean spherical
aberration of a group of individuals. Relatedly, a diagnosis or
treatment can be based on ocular characteristics of a population or
subset thereof, in addition to or instead of a patient's particular
ocular characteristic. In one embodiment, a patient treatment based
on a mean value of spherical aberration from a population of
individuals. In some cases, the mean value of spherical aberration
from a population of individuals is determined based on a
standardized pupil size. That is, within the population of
individuals it is possible to characterize a spherical aberration
characteristic with respect to a pupil size. Thus, a population
mean spherical aberration can be associated with pupil size. A
treatment for an individual patient can involve a pupil size
normalization. Relatedly, it is possible to tailor a patient
treatment based on a pupil size of the patient, and a mean value of
spherical aberration from a population of individuals. For example,
a treatment can be scaled based on the patient pupil size and the
population mean.
[0059] When a patient eye fully or maximally unaccommodates during
a wavefront measurement, the pupil size is relatively large. When
the eye accommodates, the pupil constricts and often can be about
1.5 mm smaller than the unaccommodated pupil size. In some
embodiments, a wavescan measurement can be performed under low
light. When evaluating a patient's eye under low light, for example
with an aberrometer, the pupil size is large or at or near its
maximum. It may be desirable to capture or evaluation ocular
aberrations of the patient's eye when the pupil is enlarged. If an
examination is performed under intense light or when the pupil is
constricted, there may be aberration information that is outside of
the capture area that is missed. Evaluating the eye under low light
can improve the likelihood of obtaining a reliable aberration
representation for pupil dynamics when the pupil constricts.
[0060] Step 82 involves determining a minimum accommodation
characteristic of the eye. The term minimum accommodation
characteristic can include a characteristic of the eye that
corresponds to the eye when in a minimally accommodated state. For
example, a minimum accommodation characteristic can be a pupil size
of the eye when the eye is minimally accommodated. This step can
involve compelling a patient's eye toward an unaccommodated state,
and concomitantly evaluating the accommodation status of the eye. A
minimum accommodation characteristic reflects the state of the eye
where further deaccommodation is difficult or no longer
possible.
[0061] Step 84 includes determining a target metric based on the
natural metric or the minimum accommodation characteristic. Step 86
includes determining the actual metric of the eye, and step 88
includes determining whether the actual metric meets the target
metric. These steps involve a pre-testing or pre-examination
approach whereby an accommodation status of the eye is evaluated
prior to determining whether to proceed with a wavefront or other
refractometer measurement. For example, it is possible to determine
a pupil size of the eye that corresponds to the eye in a minimally
accommodated state. The eye is then evaluated prior to a wavefront
exam. If the pupil size of the eye is sufficiently different from
the minimally accommodated pupil size, or sufficiently different
from a target metric based on the minimally accommodated pupil
size, then a decision can be made not to proceed with the wavefront
measurement. If, however, the actual pupil size is sufficiently
close to the minimally accommodated pupil size, or sufficiently
close to a target metric based on the minimally accommodated pupil
size, then a decision can be made to proceed with the wavefront
measurement. Accordingly, step 90 involves obtaining a wavefront
measurement with a WaveScan wavefront diagnostic system and
determining an optical treatment, such as a CustomVue treatment,
based on the measurement. Optionally, a procedure may include
determining a maximum accommodation characteristic of a patient
eye, as indicated by step 92. A presbyopia treatment can be
determined based on the maximum accommodation characteristic of the
eye, as indicated by step 94.
[0062] FIG. 5 provides a detailed illustration of method
embodiments of the present invention. In a first prong, method 500
includes obtaining a first induced metric for the eye that
corresponds to a first accommodation state of the eye, as indicated
by step 100. The first induced metric can include, for example, a
pupil size of the eye or a spherical aberration of the eye. The
pupil size can be measured by any of a variety of instruments, such
as a video camera. The spherical aberration can be measured by an
aberrometer such as a Hartmann-Shack device. Step 105 involves
obtaining a second induced metric for the eye that corresponds to a
second accommodation state of the eye. The second induced metric
can include, for example, a pupil size of the eye or a spherical
aberration of the eye.
[0063] This approach often involves physically pushing the eye
toward a less accommodated state, or toward a more accommodated
state, and monitoring the associated changes in the induced metric
to determine whether or to what extent the eye is accommodated. In
this way, it is possible to ascertain a model that predicts or
determines the natural metric, which may correspond to an
unaccommodated state of the eye. Any of a variety of stimuli or
optical testing apparatuses can be used to compel accommodation
changes in the pupil eye, including trial lenses, moving target,
stimulated moving targets, and the like. A trial lens system may,
for example, be used to simulate various target distances. Trial
lenses can incorporate sphere, cylinder, or other properties. This
technique often does not involve physically pushing the eye to the
completely unaccommodated or accommodated state, however. Based on
this approach it is possible to determine a relationship between
the level of accommodation and the metric (e.g. pupil size,
spherical aberrations, or vergence). In some cases, this
relationship may be a linear relationship. In other cases, the
relationship may be quadratic, logarithmic, exponential, or the
like. Typically, the relationship is linear across a patient
population.
[0064] Step 110 includes determining a natural metric of the eye
based on the first and second induced metrics. The natural metric
can be, for example, a pupil size or a spherical aberration for the
eye when it is in an unaccommodated state. Similarly, the natural
metric can be a pupil size or a spherical aberration for the eye
when it is in a minimally accommodated state, a maximally
accommodated state, or a partially accommodated state. As noted
above, a natural metric refers to a characteristic of the eye under
natural conditions, in the absence of influences that may be
present during diagnostic or testing procedures. For example, the
natural metric may refer to an eye characteristic in the absence of
a stimulus or other optical testing apparatus. In some cases, this
corresponds to a situation where there is no trial lens, or where
the amount of the trial lens power does not provide a stimulus or
induce an unwanted amount of defocus. Similarly, the intensity of
the ambient light can be adjusted or maintained so as to not
provide a stimulus. Step 120 encompasses determining a target
metric for the eye based on the natural metric. The target metric
can be, for example, a target pupil size or a target spherical
aberration of the eye. In a second prong, method 500 includes
obtaining an induced metric for the eye that corresponds to a
viewing condition, as indicated by step 200. The method can also
include adjusting the viewing condition, as shown by step 205. The
viewing condition can be adjusted, for example, by adjusting a
trial lens, by adjusting a target distance, by adjusting a
simulated target distance, and the like. Step 210 includes
obtaining an induced metric for the eye that corresponds to the
adjusted viewing condition. These induced metrics can include, for
example, a pupil size or a spherical aberration of the eye of the
patient.
[0065] In some cases, this technique can include subjecting the
patient to a series of accommodation tasks of varying diopters. For
example, an accommodation task protocol may involve adjusting the
viewing condition so as to subject the patient to sequential
diopters of 1/2D, 1/4 D, 1/2 D, 3/4 D, 1 D, 3/4 D, 1/2 D, 1/4 D, 0
D, and so on. Again, the viewing condition can be adjusted by
adjusting a trial lens system or by adjusting a target distance.
The viewing conditions can be varied in any way desired. In some
cases, the viewing conditions may include a protocol providing
sequential diopters in 0.1 D increments. Parameters of the method
can be adjusted according to the desired or required degree of
accuracy.
[0066] A presbyopia application may involve adjusting the viewing
conditions so as to provide a continually increasing diopter
protocol to the patient. Such a protocol may include, for example,
sequential diopters of 1/4 D, 1/2 D, 3/4 D, 1 D, 11/4 D, 11/2 D,
and so on. As noted previously, the protocol can be metered in 0. 1
increments. Thus, step 200 may involve obtaining an induced pupil
size for the eye that corresponds to a 1/4D viewing condition, step
205 may include adjusting a trial lens or a target distance to
change the viewing condition from 1/4 D to 1/2 D, and step 210 may
include obtaining an induced pupil size for the eye that
corresponds to the 1/2 D viewing condition. In an exemplary
embodiment, the viewing condition can be adjusted until the
patient's pupil size, or spherical aberration, or some other
metric, ceases to change or meets a certain threshold or value.
Similarly, the viewing condition can be changed until the
difference between certain induced metrics meets or exceeds a
certain threshold or value Accordingly, step 215 includes comparing
the induced metric of step 210 with the previous induced metric of
step 200. In the case of a pupil size measurement, if the
difference between a first viewing condition pupil size and a
second viewing condition pupil size is sufficiently large, then the
method may involve reiterating steps 205, 210, and 215. If the
difference between the previous viewing condition induced metric
and the subsequent viewing condition induced metric is not
sufficiently large or does not meet or exceed a certain threshold,
then method 500 can include determining an accommodation
characteristic of the eye as indicated by step 225. The
accommodation characteristic can encompass, for example, a maximum
accommodation of the eye or a minimum accommodation of the eye. In
some cases, the viewing condition is adjusted, and the induced
metric is monitored, until the induced metric no longer changes
even under continued adjustments in the viewing condition. In some
cases, the induced metric can be modulated or effected by changing
the distance of the viewing target. Relatedly, a viewing condition
can include a vergence testing or treatment parameter, which can be
varied during examination or treatment. Similar viewing conditions
are discussed in co-pending and commonly owned U.S. patent
application Ser. No. 10/872,331 filed Jun. 17, 2004, and Ser. No.
11/156,257 filed Jun. 17, 2005, the contents of which are
incorporated herein by reference. In some embodiments, it may be
desirable to evaluate or treat an eye under a vergence condition
that is zero or close to zero, or that is at some other value. A
vergence can be based on a reciprocal of a target distance. Based
on such procedures, it is possible to determine whether the eye is
minimally accommodated or maximally accommodated. The method may
involve determining whether the corresponding induced metrics, for
example pupil size or spherical aberration, have reached a certain
expected value or level. In some cases, if the difference between
the previous viewing condition induced metric and the subsequent
viewing condition induced metric is not sufficiently large or does
not meet or exceed a certain threshold, then method 500 can
optionally include iterating steps 205, 210, and 215 as indicated
by step 220.
[0067] In the case of a maximally accommodated eye, the method may
include adjusting the trial lens to sequentially increase (e.g. in
0.1 D or 0.25 D increments) the diopter for the viewing condition,
and using a video camera to track and measure the corresponding
pupil size changes. At some point, the pupil size ceases to change,
even as the viewing condition continues to be adjusted. In this
way, the method encompasses forcing the eye to the limit to
determine a forced maximum accommodation. In a preferred
embodiment, ambient light is maintained at a constant during this
procedure, as changes in ambient light may have an effect on pupil
size.
[0068] In the case of a minimally accommodated eye (or a maximally
unaccommodated eye), the method may include adjusting the trial
lens to sequentially decrease (e.g. in 0.1 D or 0.25 D increments)
the diopter for the viewing condition, and using a video camera to
track and measure the corresponding pupil size changes. Typically,
decreasing power viewing conditions are associated with increasing
pupil size dimensions. At some point or threshold, the pupil size
reaches a maximum level and does not increase, even as the viewing
condition continues to be adjusted. This can be the stage where
accommodation is completely or maximally relaxed. The adjustments
of the viewing conditions and the measurement of the induced
metrics can be automated by software.
[0069] As an illustrative example, it is helpful to consider
subjecting a patient to a variety of viewing conditions so as to
determine an accommodation characteristic of the patient's eye,
such as a maximum accommodation or a minimum accommodation of the
eye. For example, the viewing condition can be adjusted so as to
subject the patient to a series of increasing diopters values, and
the induced metric ceases to change when the viewing condition
reaches 2D, then it may be possible to determine that the patient
has 2D of residual accommodation. When determining a minimum
accommodation of the eye, the viewing conditions typically include
a progression toward decreasing diopters. Relatedly, when
determining a maximum accommodation of the eye, the viewing
conditions typically include a progression toward increasing
diopters.
[0070] Presbyopia Treatment
[0071] Method 500 can also include determining a residual
accommodation of an eye based on characteristics of the eye in a
maximally accommodated or highly accommodated state as indicated by
step 240. Residual accommodation can be related to the trial lens
power or the target distance. Residual accommodation can be based
on a power that is determined by the reciprocal of the target
distance. As a person ages, the ability to accommodate typically
diminishes. Residual accommodation reflects a measure of the
accommodative capacity that a patient retains. Thus, a patient
having a lower degree of residual accommodation exhibits more
severe presbyopia, whereas a patient having a higher amount of
residual accommodation exhibits less severe presbyopia. For
example, an eye having one diopter of residual accommodation may
allow a patient to image with good acuity anywhere throughout a
one-diopter target distance range. Residual accommodation is also
discussed in U.S. patent application Ser. No. 11/134,630 filed May
19, 2005, the entire content of which is incorporated herein by
reference. It may be desirable to include the amount of residual
accommodation in the design of a presbyopic treatment so the
patient may achieve an optimal outcome. The method may also include
a screening step, whereby a determination is made whether to treat
the patient based on the residual accommodation measurement. In
many cases, it may be easier or more desirable to optimize a
treatment shape for a patient having a higher residual
accommodation. Embodiments of the present invention encompass
screening systems and methods for choosing or selecting IOLs. For
example, an optical apparatus can include an IOL or accommodating
IOL placed in the optical path, and the IOL or accommodating IOL
can be used as part of the optical element in the optical bench.
Subjective testing can be performed for screening purposes, and
this can be done prior to surgery or treatment.
[0072] As shown by steps 250 and 255, the method may also include
obtaining aberration data, for example with a WaveScan device or
the like, and determining a presbyopia treatment based on the
residual accommodation and the aberration data. Embodiments of the
present invention encompass screening systems and methods that
determine whether to proceed with a corneal ablation treatment
based on the residual accommodation of the patient. For example, if
the residual accommodation of the patient as determined in step 240
is sufficiently large, the technique may involve proceeding with an
ablative treatment. Conversely, if the residual accommodation is
sufficiently small, the technique may involve refraining from
administering an ablative treatment to the patient. In some cases,
the threshold residual accommodation is about 0.5 Diopters, whereby
if the patient has a residual accommodation greater than about 0.5
D, an ablative treatment is administered to the patient, but if the
residual accommodation is less than about 0.5 D then the patient is
provided with a multifocal IOL. Techniques may involve aspects of
residual accommodation and threshold residual accommodation which
are discussed in co-pending and co-owned U.S. patent application
Ser. No. 11/134,630, the contents of which are incorporated herein
by reference.
[0073] In this way, the residual accommodation can be used to
determine an appropriate or desired treatment modality for a
presbyopic patient. For example, in presbyopes having a larger
amount of residual accommodation, it may be desirable to administer
a corneal reshaping treatment. In presbyopes having a smaller
amount of residual accommodation, it may be desirable to treat the
patient with a multifocal IOL. Thus, the determination can be made
based on the residual accommodation of the patient, and
independently of the age of the patient.
[0074] In some cases, when designing a presbyopia prescription
shape based on the residual accommodation, it may be desirable to
design the shape so as to maintain a substantial or maximal degree
of distance vision. However, there is often a trade off as
presbyopia correction typically involves a compromise between
optimal near vision and optimal distance vision. For example, in an
older patient having less residual accommodation, it may be
desirable to administer a treatment that includes a slightly higher
spherical aberration, thus providing an increase in near power
(near vision) but a decrease in far power (distance vision). In a
patient having more residual accommodation, it may be desirable to
administer a treatment that includes a less aggressive aspheric
component, thus providing less of an increase in near power and
less of a decrease in far power. Often, the process of designing a
prescription shape includes decisions regarding the management of
simultaneous near and far vision, as well as whether the near
vision meets or approaches a desired threshold or standard.
[0075] CustomVue Procedure
[0076] The WaveScan wavefront diagnostic system measures
aberrations of the ocular optical system. Based on wavefront
measurements, the system generates graphic displays of those
aberrations, generates mathematical models of the aberrations, and
transmits aberration data for use by a VISX laser eye surgery
system. In addition to standard optical defects such as myopia,
hyperopia, and cylindrical astigmatism, this diagnostic tool
provides objective measurements of higher-order aberrations of the
eye. VISX laser eye surgery systems can direct ablative laser
energy from an excimer laser toward a cornea of a patient. A
processor of the VISX laser system can direct a pattern of the
ablative energy toward the corneal tissue so as to alter the shape
of the cornea, effectively changing the shape of the corneal lens.
The corneal stroma is selectively ablated by the laser energy so as
to resculpt the cornea, modifying the refraction provided by the
cornea itself. In a CustomVue treatment procedure, the pattern of
ablative energy is derived from the wavefront aberration data
measured by the WaveScan wavefront diagnostic system so as to
correct low and high-order aberrations of the eye, thereby
providing a corrected visual performance that often exceeds that
available through standard corrections such as off-the-shelf
spectacles or contacts.
[0077] Method 500 can also include determining a target metric
based on a minimum accommodation characteristic of an eye, as
indicated by step 245. This approach includes pushing the eye to or
toward an unaccommodated or minimally accommodated state. For
example, the approach may involve asking or forcing the patient to
accommodate, via a trial lens system or a changing target distance
protocol, so as to induce sphere in the eye. Then, the distance
between the patient and the target can be decreased, or the trial
lens system can be adjusted toward decreasing powers, so as to
reduce the plus lens. Eventually the patient will approach or reach
an unaccommodated or minimally accommodated state. The target
metric can be calculated based on the unaccommodated or minimally
accommodated state of the eye.
[0078] As indicated in step 300, the method may also include
determining an actual metric of the eye. For example, a video
camera can be used to determine the actual, and in some cases real
time, pupil size or dimension of the eye. Similarly, a
Hartmann-Shack device can be used to determine an actual spherical
aberration of the eye. Step 305 includes determining whether or to
what degree the actual metric meets or approaches the target
metric. This step may involve determining whether the eye is
unaccommodated or minimally accommodated. In this way, an operator
can ensure that the examined eye is unaccommodated, minimally
accommodated, or the like, which may indicate that instrument
myopia is no longer induced, and that there is no vergence. The
determination can be based on aberration data, the pupil size, or
some other data. This technique is helpful in decreasing or
eliminating error in situations where the patient's eye is
continuing to accommodate somewhat. In certain CustomVue
treatments, when the eye accommodates the reported wavescan is not
accurate for sphere or spherical aberration, and it may be
difficult to determine whether the eye is unaccommodated as
desired. In some cases, the determination of an unaccommodated
state may be difficult because of microaccommodation and the tear
film fluctuations. Embodiments of the present invention provide a
systematic way of compelling the patient toward an unaccommodated
state.
[0079] According to embodiments of the present invention, it is
therefore possible to monitor the actual metric (e.g. pupil size)
to determine whether or to what extent the eye of the patient is
approaching an unaccommodated or minimally accommodated state. If
the actual metric does not meet the target metric, the method may
include adjusting the viewing condition so as to push the eye
toward a more accommodated state or toward a less accommodated
state. This can be accomplished with a trial lens system, a moving
target, a simulated moving target, and the like. The method may
also include providing a signal to the operator indicating whether
a maximally or highly unaccommodated state is reached or
maintained. Further, the method may include making a decision
whether to proceed with an ocular aberration measurement or not,
based on whether or to what degree the actual metric approaches or
meets the target metric, as indicated by step 3 10. As noted
previously, the target metric can be determined by step 120 (based
on natural metric) or by step 245 (based on minimum accommodation
characteristic).
[0080] The ocular aberration measurement of step 310 may include a
wavescan exam. For example, if the actual accommodation state of
the eye meets the target accommodation state, the method proceeds
with a full wavefront scan. Typically, the trial lens is removed
from the optical path prior to taking the aberration measurement.
Embodiments of the present invention encompass techniques that
involve compelling the eye toward a deaccommodated state, and
measuring a wavefront of the eye when the eye is in a minimally
accommodated state.
[0081] In this way, it is possible to ensure that the accommodation
state of the eye is known when the ocular aberration measurement is
taken. For example, it may be desirable to ensure that the eye is
unaccommodated or substantially unaccommodated when a wavescan exam
is performed. In some cases, it may be possible to proceed directly
to ocular aberration measurement of step 310 after determining that
threshold is not exceeded in step 225.
[0082] As shown in step 315, the method may include alerting a
system operator if the actual metric does not meet the target
metric. For example, the patient may not be sufficiently
deaccommodated. Optionally, the method may include adjusting the
viewing condition in an attempt to change the actual metric of the
eye, as indicated by step 317. The method may then include
returning to step 300 to determine the actual metric of the
eye.
[0083] Thus, embodiments of the present invention provide a series
of pre-examination measurements, whereby a method may encompass
performing a series of preliminary validation steps prior to the
aberration measurement. Typically, these tests involve induced
vergence or induced myopia. In order to ascertain the desired
parameters, such as the state of a minimally accommodated eye, the
method may involve pushing the eye toward a less accommodated state
or a more accommodated state. When the pretesting is complete, the
testing optics can be removed and the aberration measurement can
proceed. In a typical scenario, prior to a wavefront exam a patient
is subjected to a trial lens protocol that pushes the eye from a
more accommodated state toward a less accommodated state. If the
patient eye does not reach a desired level of unaccommodation, the
method may include providing a warning message to the system
operator that the eye is not sufficiently unaccommodated. If the
patient eye reaches the desired level of unaccommodation, the
method may include proceeding with a wavescan exam. The method may
or may not include removing the optical testing apparatus from the
optical path prior to the aberration measurement. For example, when
evaluating a pupil size metric, it may be possible to leave a trial
lens in the optical path. Conversely, when evaluating a spherical
aberration metric, it is often desirable to remove a trial lens
from the optical path prior to performing the ocular aberration
measurement.
[0084] In some embodiments, a method may include measuring a
plurality of spherical aberrations to determine an accommodation
profile of an eye. In this way, it is possible to determine an
ocular aberration relative to a spherical aberration structure.
[0085] FIGS. 6A-6C illustrate the effects of changing focal
distance on a patient's lens. In some cases, a large pupil size may
be beneficial in capturing such information. SA measurements may be
used to characterize or predict the hardness of a nucleus. It is
possible to derive a spherical aberration of a nucleus based on a
total ocular spherical aberration and a topography measurement of
spherical aberration of a comea. Embodiments provided herein
encompass models which reflect a person's age, the hardness of the
nucleus, and the spherical aberration. For example, it is possible
to build a model where as a person ages, a nucleus becomes harder,
and spherical aberration increases. Models may be constructed from
population studies, to support predictions of nucleus
characteristics, such as hardness, based on spherical aberration
measurements. A human crystalline lens consists of material having
a gradient index of refraction. Spherical aberration and other
aberration parameters can change during accommodation, as well as
during mini-accommodation or micro-accommodation, because of the
corresponding change in shape of the crystalline lens. Thus,
accommodation involves a change in lens shape accompanied by a
change in optical aberrations. For example, a lens in a less
accommodated state can be flatter, having a lower diopter and
higher focal length. In contrast, a lens in a more accommodated
state can be more round, having a higher diopter and a smaller
focal length. In an unaccommodated state, the spherical aberration
of the eye or lens is relatively small. When the eye accommodates,
the shape of the lens becomes more round or bulging, thus
increasing the amount of spherical aberration. Typically, as a
person ages the capacity for the eye to accommodate diminishes. It
has also been observed that the pupil constricts as the eye
accommodates. However, in many cases the amount of pupil
constriction is independent of the patient's age. FIG. 6A shows a
target 610a at or near optical infinity, with a high focal distance
D.sub.a. Accordingly, lens 620b is relatively flat, has a low
diopter, and is in a more relaxed accommodation state. FIG. 6B
shows a target 610b that is closer to the eye, with a medium focal
distance D.sub.b. Accordingly, lens 620b is somewhat bulging. FIG.
6C shows a target 610c that is very close to the eye, with a short
focal distance D.sub.c. Accordingly, lens 620c has a highly bulging
shape. The sphere and spherical aberration components typically
change in these situations. For example, the sphere and spherical
aberration can be relatively small in FIG. 6A, intermediate in FIG.
6B, and relatively large in FIG. 6C. As FIGS. 6A-6C illustrate, as
a target moves closer to the eye, the lens adopts a greater
curvature so as to keep the target in focus. In a presbyopic
patient, the ability to transition from a flatter lens to a bulging
lens is diminished. Thus, the lens remains flatter, even when the
patient is trying to gaze at a near distance, for example when
reading a newspaper.
[0086] In many optical procedures where the patient is subject to
the influence of optical testing machinery, it may be difficult or
impossible for the patient to completely relax the lens of the eye.
Accordingly, there is often some accommodation, which may be
referred to as instrument myopia. This instrument myopia may be
present even when the patient is trying to suppress the
accommodation. Hence, optical measurements that are designed to
reflect the status of the eye may include some amount of
accommodation. It is useful to characterize the relationship
between an optical measurement and the accommodation of the eye.
FIG. 7A graphically illustrates a relationship between a spherical
aberration (y axis) and an accommodation state (x axis) of the eye.
An exemplary procedure may include monitoring the patient's
wavefront scan under a variety of different viewing conditions, for
example a series of accommodation tasks. A metric such as spherical
aberration can be determined from the wavefront, and synchronized
or correlated with the accommodation tasks. As shown here, as the
eye becomes more accommodated in response to changing viewing
conditions. The increase or change in accommodation can be in
response to, for example, a stimulus such as an optical testing
apparatus, which induces the amount of spherical aberration in the
eye to increase or otherwise change. A first induced spherical
aberration can be represented by point A, and a second induced
spherical aberration can be represented by B.
[0087] In one illustrative example, a patient accommodates to a
target and a wavefront measurement is taken. The target is then
moved, and another wavefront measurement is taken. This can be
driven by known change in sphere. For example, a target distance
can be moved from 1 meter to 2 meters, or from 1 meters to 0.5
meters, or the like. Similarly, a target distance can be fixed and
a trial lens can be manipulated by changing the sphere. This can
provide a similar effect to changing the target distance or
vergence viewing condition. By analyzing the wavefront readings, it
is possible to correlate a change in ocular aberration with the
state of accommodation in the eye. A wavefront measurement or
metric corresponding to the unaccommodated eye (e.g. zero
accommodation) can be extrapolated or determined based on this
correlation.
[0088] A relationship between spherical aberration and
accommodation can be established based on the induced metrics, and
the relationship can be used to determine or predict metric values
at various levels of accommodation. For example, it is possible to
predict or extrapolate the spherical aberration at point C, which
corresponds to the eye in the unaccommodated state. Zero
accommodation is analogous to eye gaze at infinity. A similar
approach can be used to predict or extrapolate a patient's pupil
size or dimension for a given amount of accommodation. Related
methods include qualifying a certain wavefront measurement out of
several wavefront measurements.
[0089] FIG. 7B graphically illustrates a relationship involving
residual accommodation and range of accommodation.
[0090] A residual range of accommodation can be quantified or
configured, and algorithms can derive a presbyopia shape.
[0091] Parameters for design include the Residual Range of
Accommodation, which may be particularly useful for designing a
presbyopia treatment. Pupil dynamic parameters can also be used in
the design of a presbyopia treatment.
[0092] Based on data from the relationship shown in FIG. 7B, it is
possible to determine an optimal accommodation pattern for a
specific patient, and therefore it is possible to determine an
optimal vision correction treatment for the patient. In some cases,
the vision treatment encompasses a treatment for presbyopia. For
example, some patients may benefit from a reduced amount of add in
the presbyopic correction. As depicted in FIG. 7B, residual
accommodation is represented by the portion where the line levels
off horizontally, which corresponds to a maximally accommodated
eye.
[0093] FIG. 7C graphically illustrates a relationship involving
optical characteristics of an eye. The point A represents a typical
or normal patient. Point B represents an older patient that has
presbyopia. A typical wavefront aberration includes contributing
factors such as a lenticular aberration (or lens aberration) and a
corneal aberration. Often, however, it is difficult to determine
from a wavefront scan which wavefront aberrations derive from
lenticular aberrations and which derive from corneal aberrations.
It may be desirable to characterize the contributing factors of the
wavefront. One approach involves the assumption that the corneal
aberrations are known, and that the lenticular aberrations vary in
response to changing viewing conditions or stimuli. Hence, it is
possible to evaluate changes in the wavefront that occur in
response to the viewing conditions, and attribute these changes to
lenticular aberrations. Based on this approach, it is possible to
determine what factors contribute to a wavefront aberration.
[0094] Advantageously, it has been discovered that through-focus
measurements of an ocular wavefront can be used to derive
accommodation-free refraction, and thus lenticular (lens)
contribution to ocular wavefront can be determined, for example
based on a combination of topographic data and ocular wavefront
measurement data, it is possible to derive a lenticular
contribution.
[0095] FIG. 7D graphically illustrates a relationship between an
accommodation state (y axis) and a pupil size or dimension (x axis)
of the eye. An exemplary procedure may include monitoring the
patient's eye under a variety of different viewing conditions. The
viewing conditions may encompass a series of accommodation tasks.
The method may also include correlating the pupil dimension metric
with the accommodation status. As shown here, an increase in pupil
dimension is correlated with a decrease in the level of
accommodation in the eye. A relationship between accommodation and
pupil size can be established based on these values. It is
therefore possible to extrapolate to determine a pupil size that
corresponds to a zero accommodation state of the eye. Often,
determination of an accommodation-free pupil size is achieved under
consistent, calibrated ambient lighting. Thus, lighting can be
calibrated for pupil size purposes. Based on the data provided by
FIG. 7D, it is possible to determine an accommodation value for a
particular pupil size.
[0096] As shown in FIG. 7D, a maximum accommodation state of the
eye can correspond to a minimum pupil size of the eye, and this can
be determined by adjusting an accommodation target or stimulus.
Based on this data, it is possible to calculate the residual
accommodation, which can be described as the amount of
accommodation that remains in the eye. The residual accommodation
can be calculated based on a distance between the eye and the
target. Patients having more severe presbyopia have less residual
accommodation Patients with milder presbyopia have more residual
accommodation. Pupil size thus can be an independent indicator of
accommodation.
[0097] FIG. 7E graphically illustrates a relationship between a
spherical aberration (y axis) and a pupil size or dimension (x
axis) of the eye. An exemplary procedure may include monitoring the
patient's pupil size under a variety of different viewing
conditions, for example a series of accommodation tasks. A metric
such as pupil diameter can be determined by a video camera, and
synchronized or correlated with the spherical aberration, which may
be determined based on a wavefront scan. As shown here, an
increased pupil size correlates with a decreased spherical
aberration. A relationship between spherical aberration and pupil
size can be established based on these values.
[0098] FIG. 8 depicts relationships between accommodation, pupil
size, and net spherical aberration according to embodiments of the
present invention. In an exemplary technique, a series of
accommodations tasks is given to a patient, and a corresponding
series of wavefront measurements is taken. As the accommodation
response results in a change of the eye lens, characteristic ocular
aberrations such as sphere (defocus), spherical aberration (shape
change), and coma (lens decentration) can be correlated with
different values of the wavefront bias or spherical bias due to
instrument myopia. Aberrations can also be correlated with
different values of pupil size. These metrics can be used to
determine a prescription for an optimal IOL, an accommodating IOL,
and the like, or for the derivation of design parameters for a
multi-focal presbyopic correction on the comea. For example, a
spherical aberration metric or a pupil metric can be used to design
an optimal IOL or an accommodating IOL. A population mean can be
determined, and an IOL design can be optimized so as to correct or
treat a certain amount of spherical aberration for an optimal or
specific pupil size. As shown here, as the diopter of the
accommodation task increases, the spherical aberration increases,
and the pupil size decreases. By determining a relationship between
these factors, it is possible to derive the accommodation zero
point from the line based on the mesopic pupil size of the patient,
where the mesopic pupil size corresponds to the eye is a normal
unaccommodated condition. In some embodiments, it is possible to
train down the spherical aberration line line, and determine a
point where amount of spherical aberration no longer changes when a
trial lens power is reduced. This is a point where it is possible
to derive the accommodation. In some embodiments, residual
accommodation may be used to determine the amount of accommodation
desired for an accommodating IOL. It is also possible to design
aberration corrections into an accommodating IOL to reduce changing
aberrations as the eye accommodates. An amount of spherical
aberration can be predesigned for an IOL, such that when the IOL is
in an accommodating situation, an amount of spherical aberration is
provided for a desired or optimal performance. If the eye exhibits
non-linear accommodation, it may be possible to design an
accommodating IOL to compensate.
[0099] FIG. 9 depicts relationships between accommodation, pupil
size, and net spherical aberration according to embodiments of the
present invention. A series of accommodations tasks is given to an
IOL patient, and a corresponding series of wavefront measurements
is taken. The pupil size decreases as the diopter of the
accommodation task increases. However, because it may be difficult
or impossible for an IOL patient to accommodate, the spherical
aberration is observed to decrease as the diopter of the
accommodation task increases.
[0100] Embodiments of the present invention are well suited for use
in designing and developing custom multifocal IOLs, corneal inlays
and onlays, and contact lenses. Embodiments of the present
invention also encompass systems and methods for developing and
designing IOLs and accommodating IOLs. For example, it is possible
to evaluate accommodating IOLs after implantation to determine the
optimal or desired amount of spherical aberration for an IOL. Data
can be re-input or reiterated to refine accommodating IOLs. A
population study can be performed for patients who have received
implants. Data from the study can be used to determine a spherical
aberration that is helpful for a patient. For example, it is
possible to determine an amount of spherical aberration for a
certain type of accommodating IOL. In many current situations,
accommodating IOLs do not include a gradient index material. If an
accommodating IOL includes a gradient index material or involves a
two piece optic accommodating IOL, there may be a change of
spherical aberration. This can mimic a real natural crystalline
lens, and can be used for similar studies.
[0101] Typically a lens of an eye exhibits a varying gradient index
of refraction. In contrast, a polymer-filled bag often has a
uniform index of refraction.
[0102] Each of the above calculations or operations may be
performed using a computer or other processor having hardware,
software, and/or firmware. The various method steps may be
performed by modules, and the modules may comprise any of a wide
variety of digital and/or analog data processing hardware and/or
software arranged to perform the method steps described herein. The
modules optionally comprising data processing hardware adapted to
perform one or more of these steps by having appropriate machine
programming code associated therewith, the modules for two or more
steps (or portions of two or more steps) being integrated into a
single processor board or separated into different processor boards
in any of a wide variety of integrated and/or distributed
processing architectures. These methods and systems will often
employ a tangible media embodying machine-readable code with
instructions for performing the method steps described above.
Suitable tangible media may comprise a memory (including a volatile
memory and/or a non-volatile memory), a storage media (such as a
magnetic recording on a floppy disk, a hard disk, a tape, or the
like; on an optical memory such as a CD, a CD-R/W, a CD-ROM, a DVD,
or the like; or any other digital or analog storage media), or the
like.
[0103] While the exemplary embodiments have been described in some
detail, by way of example and for clarity of understanding, those
of skill in the art will recognize that a variety of modification,
adaptations, and changes may be employed. Hence, the scope of the
present invention should be limited solely by the claims.
* * * * *